topic Re: Extra Help with Medicare Part D in Personal Finance

Extra Help with Medicare Part D

AndrewF — Sat, 20 Jun 2026 15:49:43 GMT

Now that I've moved out of my spouse's apartment and am no longer living with him, I qualify for Extra Help with Medicare Part D again.

It's much easier to qualify and sign up for than other assistance programs, so I started with this.

I would be paying over $600 a year in generic drug copays buying 6 months at a time with GoodRX Gold, plus the GoodRX Gold membership, but now that I'm not living with my spouse, Medicare should be paying for a lot of this.

That will relieve me of a substantial amount of medical costs by capping my prescription drug co-pays to $5.10 for generics for 90 day fills, and like $12 and something for brand name fills.

With costs for everything soaring, especially rent and food, everyone who qualifies under Social Security's rules should sign up. Social Security estimates there are at least two million people on Medicare who could get the help who have not applied, and the form is very easy, just asking basic questions about your living situation and how much money you have.

It even excludes the home you're living in, your most expensive car, and some other things. Check it out if you think you can apply.

As a single person you can now have over $18,000 in countable assets and (iirc) over $1900 a month in total income.

I'll be looking at what other assistance I qualify for now that I'm out of the house. I would have strongly preferred that the marriage had continued in perpetuity had it even been a decent one, but when someone emotionally abuses you for years eventually you cannot take it anymore and would sign a Faustian Contract to get away from them. Which is, I feel, what the rent where I'm living at now is. Very oppressive rent. Have to figure out how to free up enough room to come up with half of it. :/

Re: Extra Help with Medicare Part D

crystal626 — Sun, 21 Jun 2026 01:43:54 GMT

Extra Help is very nice. My meds would be $600 without it.

If you're disabled, look into Medicaid. Income limits are higher for disabled people through the waiver system.

Sorry to hear about the split though.

Re: Extra Help with Medicare Part D

AndrewF — Sun, 21 Jun 2026 16:23:35 GMT

The Medicare Savings Program is stingier in many states than Extra Help for Part D.

After I pay off the credit cards for moving in here I might qualify for MSP again but for right now I'm doing what I can.

The problem you run into with MSP is if you're so good with money you manage to save more than the program allows. How messed up is that?

So if you go buy a $5,000 bed for your new apartment then apply you might get back on it, but not if you keep the $5,000 and have a crappy bed.

So get a nice bed, is what I have to say about that. YOLO

Re: Extra Help with Medicare Part D

bs1234 — Sun, 21 Jun 2026 19:04:33 GMT

When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)

Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95. The first fill then hits the cap ($2100) and all other covered meds are free. Other plans were $200 a month and, in my case, for no gain.

Let's see what the sign up for 2027 is like.

Re: Extra Help with Medicare Part D

FicoMike0 — Mon, 22 Jun 2026 03:57:05 GMT

You have to check all the plans each year. The one I presently have is "cash back". It refunds nearly all of the part b premium.

The only downside I've found is blood tests that were previously covered 100% now cost me $10. So, $20-30 a year vs +$150+ a month.

Re: Extra Help with Medicare Part D

crystal626 — Mon, 22 Jun 2026 04:05:13 GMT

@AndrewF wrote:
The Medicare Savings Program is stingier in many states than Extra Help for Part D.

After I pay off the credit cards for moving in here I might qualify for MSP again but for right now I'm doing what I can.

The problem you run into with MSP is if you're so good with money you manage to save more than the program allows. How messed up is that?

So if you go buy a $5,000 bed for your new apartment then apply you might get back on it, but not if you keep the $5,000 and have a crappy bed.

So get a nice bed, is what I have to say about that. YOLO

Yeah the resource limits can be a real pain. They pretty much don't want to help you unless you're one crisis away from homelessness.

Re: Extra Help with Medicare Part D

crystal626 — Mon, 22 Jun 2026 04:05:58 GMT

@bs1234 wrote:
When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)
Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95. The first fill then hits the cap ($2100) and all other covered meds are free. Other plans were $200 a month and, in my case, for no gain.

Let's see what the sign up for 2027 is like.

The cap is supposed to go to $2400 next year from what I was reading.

Re: Extra Help with Medicare Part D

Thomas_Thumb — Mon, 22 Jun 2026 22:06:40 GMT

@bs1234 wrote:
When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)
Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95. The first fill then hits the cap ($2100) and all other covered meds are free. Other plans were $200 a month and, in my case, for no gain.

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026.

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

Re: Extra Help with Medicare Part D

AndrewF — Tue, 23 Jun 2026 03:12:11 GMT

@Thomas_Thumb wrote:
@bs1234 wrote:
When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)
Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95. The first fill then hits the cap ($2100) and all other covered meds are free. Other plans were $200 a month and, in my case, for no gain.

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026.

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

Value Script is still $0 in Illinois.

MSP is a pain in the butt because the State already knows how much is in your bank account because Maximus tells them, but it's like filing taxes.

Every year you have to complete recertification forms then Maximus tells them if you're lying.

There's a pilot program where they deem you eligible by just looking at Maximus and don't bother you with forms, but that's new. Maximus tells them every few months, so they'll know if you have too many assets much faster and remove you before your recertification date if that happens.

Re: Extra Help with Medicare Part D

crystal626 — Tue, 23 Jun 2026 04:41:33 GMT

@AndrewF wrote:
@Thomas_Thumb wrote:
@bs1234 wrote:
When I was signing up at the end of 2025, Part D program costs in my area varied hugely (and of course there weren't many of them now!)
Since I take some very expensive drugs ($20K per fill) it made sense to go with the cheapest that covered it, which was only $8.95. The first fill then hits the cap ($2100) and all other covered meds are free. Other plans were $200 a month and, in my case, for no gain.

I use Wellcare value script. Monthly premiums were $0 in 2025 but $9.60 in 2026.

I also take some expensive meds. Reached the $2100 cap with June refills this year. A couple meds dropped over 70% in cost extending time to hitting cap. Last year reached the $2000 cap with March refills.

The current cost killers for me are premiums: Medicare part B $202/mo, basic supplemental with riders and no copays $330/mo, and dental+vision $68/mo. That's $7200 a year just for premiums. Unfortunately, low cost Medicare Advantage plans are not a viable option due to limited acceptance and issues with coverage of procedures/treatments.

Value Script is still $0 in Illinois.

MSP is a pain in the butt because the State already knows how much is in your bank account because Maximus tells them, but it's like filing taxes.

Every year you have to complete recertification forms then Maximus tells them if you're lying.

There's a pilot program where they deem you eligible by just looking at Maximus and don't bother you with forms, but that's new. Maximus tells them every few months, so they'll know if you have too many assets much faster and remove you before your recertification date if that happens.

It would be great if all states automated that system instead of harrassing people for bank statements when they already know what's in the account.

Re: Extra Help with Medicare Part D

TrapLine — Tue, 23 Jun 2026 09:34:05 GMT

This has been a very interesting and fact filled post. Frankly, I had no idea until now.

Re: Extra Help with Medicare Part D

AndrewF — Thu, 25 Jun 2026 03:24:47 GMT

@TrapLine wrote:
This has been a very interesting and fact filled post. Frankly, I had no idea until now.

Social Security automatically deems some people eligible. When you apply for Extra Help you can have them contact your state about MSP, and if you get MSP you automatically get Extra Help.

Indiana was spending more on putting disabled people on Medicaid after I sued them and got a state law overturned and that had the effect of forcing them to admit that if Social Security says you're disabled, you're disabled, so they eventually transferred many people who were dual eligible to MSP.

There's three levels of MSP. Depends on your income. There's QMB (Qualified Medicare Beneficiary), this is the best one, I was on this one in Indiana. They pay your Part B Premium and any co-pays from Part B and you automatically get Extra Help from Part D from Medicare.

Then there's Specified Low Income Beneficiary (SLIB). This is what I qualified for under Illinois rules. It just pays your Medicare Part B premium and you get Extra Help.

Then there's QI, which is Qualified Individual. It's pretty much the same thing as SLIB except it lets you have higher income. The main difference is QI only has so many spots, and when they're gone, you're on a waiting list, basically for slots to come open because someone died or moved out of the state or became ineligible and freed up a slot.

Re: Extra Help with Medicare Part D

crystal626 — Thu, 25 Jun 2026 04:25:33 GMT

MSP limits are so low that I don't qualify for any of them but thankfully I come in just under the limit for Extra Help.

Re: Extra Help with Medicare Part D

TrapLine — Thu, 16 Jul 2026 12:18:39 GMT

@FicoMike0 wrote:
You have to check all the plans each year. The one I presently have is "cash back". It refunds nearly all of the part b premium.
The only downside I've found is blood tests that were previously covered 100% now cost me $10. So, $20-30 a year vs +$150+ a month.

Affirm the reviewing all available Medicare Part D Plans (drugs). I have changed virtually every year. My big find for 2026 was six plans for my zipcode and four had their formularies set up such that one of my $400 a month drugs was not coverd. Narrowed it down to two plans.

The game every year is more than premium price.

The truth is, examining the drug formularies is key, drug plan providers fob this off and try to focus our attention on monthly premiums. Monthly premiums may actually may be the lesser of the evils. Drug Formulary is key.

Re: Extra Help with Medicare Part D

AndrewF — Thu, 16 Jul 2026 03:32:45 GMT

@TrapLine wrote:
@FicoMike0 wrote:
You have to check all the plans each year. The one I presently have is "cash back". It refunds nearly all of the part b premium.
The only downside I've found is blood tests that were previously covered 100% now cost me $10. So, $20-30 a year vs +$150+ a month.

Affirm the reviewing all available Medicare Part D Plans. I have changed virtually every year. My big find for 2026 was six plans for my zipcode and four had their formularies set up such that one of my $400 a month drugs was not coverd. Narrowed it down to two plans.

The game every year is more than premium price.

The truth is examining the Formularies provided that they (drug plan prividers) fob off and soft pedal. Monthly premiums may actually may be the lesser of the evils. Drug Formulary is key.

The formulary for all of them is crap for me because the coverage for generics does not compare favorably to GoodRX Gold.

I'm still waiting to hear back from Social Security on Extra Help but I have a six month supply of all my maintenance meds so I can wait. I called today and they picked up the phone faster than they ever have but the person was not very helpful.

All she could see was that my application was sitting there since June 19th.

Couldn't tell me when it would be processed. Just "whenever they get to it".

In 2010 when I qualified the first time it took them two weeks.

I heard that the DOGE bloodbath at Social Security pretty much wiped out every department except the one they want accusing people who probably didn't do anything illegal of fraud. They accused at least a few people I heard of, of being dead.

Then the dead people came to the office wanting to know why their benefits were shut off. You know, if there's fraud involving a dead claimant the last thing a fraudster is gonna do is go to the office as the allegedly dead person with all their ID documents.

The Fraud Unit has been around forever and it's a big country so they've definitely found some brazen people though. I remember one guy saying he had a back injury and they found him doing wrestling matches and another woman said she was disabled and then pulled up in a taco truck outside the office that was handling her case.

Some of it is really too weird to make up, but in a country where millions are on a program and the actual fraud rate is 0.1%, you will have thousands and that unit does need to exist, but their attitude lately has been "shoot first" and that's disturbing.

So there's no telling when I might hear about my Extra Help. It's probably barely a priority in this environment.

Re: Extra Help with Medicare Part D

crystal626 — Thu, 16 Jul 2026 17:25:24 GMT

@AndrewF wrote:
@TrapLine wrote:
@FicoMike0 wrote:
You have to check all the plans each year. The one I presently have is "cash back". It refunds nearly all of the part b premium.
The only downside I've found is blood tests that were previously covered 100% now cost me $10. So, $20-30 a year vs +$150+ a month.

Affirm the reviewing all available Medicare Part D Plans. I have changed virtually every year. My big find for 2026 was six plans for my zipcode and four had their formularies set up such that one of my $400 a month drugs was not coverd. Narrowed it down to two plans.

The game every year is more than premium price.

The truth is examining the Formularies provided that they (drug plan prividers) fob off and soft pedal. Monthly premiums may actually may be the lesser of the evils. Drug Formulary is key.
The formulary for all of them is crap for me because the coverage for generics does not compare favorably to GoodRX Gold.

I'm still waiting to hear back from Social Security on Extra Help but I have a six month supply of all my maintenance meds so I can wait. I called today and they picked up the phone faster than they ever have but the person was not very helpful.

All she could see was that my application was sitting there since June 19th.

Couldn't tell me when it would be processed. Just "whenever they get to it".

In 2010 when I qualified the first time it took them two weeks.

I heard that the DOGE bloodbath at Social Security pretty much wiped out every department except the one they want accusing people who probably didn't do anything illegal of fraud. They accused at least a few people I heard of, of being dead.

Then the dead people came to the office wanting to know why their benefits were shut off. You know, if there's fraud involving a dead claimant the last thing a fraudster is gonna do is go to the office as the allegedly dead person with all their ID documents.

The Fraud Unit has been around forever and it's a big country so they've definitely found some brazen people though. I remember one guy saying he had a back injury and they found him doing wrestling matches and another woman said she was disabled and then pulled up in a taco truck outside the office that was handling her case.

Some of it is really too weird to make up, but in a country where millions are on a program and the actual fraud rate is 0.1%, you will have thousands and that unit does need to exist, but their attitude lately has been "shoot first" and that's disturbing.

So there's no telling when I might hear about my Extra Help. It's probably barely a priority in this environment.

A friend of mine has been waiting to see the ALJ for her disability case for over 2 years at this point. She is starting to give up hope of ever getting in front of a judge and that's WITH them expediting her because she's technically homeless.

Re: Extra Help with Medicare Part D

AndrewF — Thu, 16 Jul 2026 22:33:53 GMT

@crystal626 wrote:
A friend of mine has been waiting to see the ALJ for her disability case for over 2 years at this point. She is starting to give up hope of ever getting in front of a judge and that's WITH them expediting her because she's technically homeless.

It was over 18 years ago. I won my case with no lawyer in about six months.

These people are the government and they move at their own sweet pace. By the time I got approved my landlord had nailed an eviction notice to my door. I asked him to hurry up and post a five day notice to cure or quit so that I could take it to the Township Trustee and the Salvation Army before I got any further behind.

That has to be the first time a tenant who was behind on rent asked their landlord to initiate an eviction warning.

Technically under State Law, the landdlord can notice you once you are a week behind. That one had a bad habit of giving people a lot of second chances while their rent was falling 2, 3, or even in one case 6 months behind.

So the irony of walking in and asking him to start evicting me isn't lost on me here.

But they started my SSDI checks soon after that so I was actually current on the rent when they started.

Back before I became disabled, I worked at Walmart for a while. It was always something there. My ex-boyfriend Ellis had a food stamp card.

I obeyed the rules religiously and made sure not to eat anything he bought with his card. We had a system. If he bought it with a food stamp card, it got a red sticker on it.

Nobody actually comes in and checks but I never want to break a law.

It is perfectly legal to send a designated shopper to the store for you if they have your permission to buy groceries you asked them to pick up, and they can use your card, and the FSSA was well aware that I was his designated shopper because I worked where they sold food and he had no car.

One of the cashiers reported me for "using someone else's food stamp card". There was an investigation, it didn't last long before they closed the investigation and said I did not do anything wrong. But it was stressful to get a letter like that.

So when I got the letter saying the investigation was over and they cleared me of any wrongdoing, I went to Ashley's checkout lane and told her that and said to mind her own business.

She went to the managers with that and they wrote me up for calmly telling her to mind her business.

Later, in a totally unrelated incident, we were all clocking in for third shift and part of the route was through Receiving and out to the floor.

Ashley happened to be in front of the receiving door when an unloader lost control of a pallet jack full of potatoes that ran into her and pinned her against the wall. The managers had to drive her to the urgent care and her arm ended up being in a sling for a while.

I chuckled about it in front of the manager who wrote me up for telling her to mind her business regarding the food stamps. He gave me a really dirty look. I thought "Oh no, now he'll fire me." but nothing ever happened regarding that.

Separately, I hate being Disabled. I hate feeling like I can't pull my own weight and earn my keep. It hits me right in the pride, especially when someone makes a scornful remark. At the same time, ask me if I miss the "workplace personalities" like Ashley or Sandy. (Sandy was worse, she ran to management about anything and everyone, but Ashley made me the subject of a government investigation that cleared me, but only after a lot of stress, and ended up resulting in a mark on my permanent record at Walmart).